Flashcards in NSAIDS and non narctoics Deck (61):
3 functions of Anti- Inflamatories NSAIDs
Pharmacokinetics of NSAIDs, where are they metabolized, how are they excreted
-food doesn't change availability
-get in synoviral fluid good for arthritis
-metabolized by liver
MOA of NSAIDS
they inhibit the cyclooxygenase enzyme (COX).
COX needed to make prostaglandins (PG)
What does COX make and why is this product needed?
1) makes PG- needed for maintinance of body
PG protect mucosal layer of stomach, regulate blood flow to the kidney & allow platelets to function
What activates COX 2?
Do COX 2 inhibitors specificly only inhibit COX 2
no only a little more
What is the only COX 2 inhibitor ?
Most ADRs of NSAIDs are related to inhibiting which cox?
GI side effects of NSAID
1) increased gastric acid bc PGs is GI mucosa protective
3) Gastro Duodenal Ulcer
During what time period of treatment dose hepatotoxicity from NSAIDs occur?
first 6 weeks
What to monitor and how often when pt. is on NSAIDs
-serum transaminases measured every 2 weeks for long term treatment
Black Box warning on NSAIDs is for what?
- cardiovascular thrombotic events
- myocardial infarctions
What do NSAIds cause you retain?
salt and fluid
How many points do NSAIDs raise ur BP?
an unstable complement system which is activated by inhibition of prostaglandins
who do you avoid using NSAIDs in?
asthmatic pts w/ polyps
-irreversibly inhibits COX enzymes, platelet effect last 10 days
dont have any effect on platelets
Do NSAIDs increase or decrease serum creatinine?
increase bc decrease blood flow to kidney
when is there an absolute contraindication to NSAIDs?
Abnormal kidney function
CNS effects of NSAIDs
which NSAIDs are the ones known for causing HAs?
which NSAIDs are the ones known for causing aseptic meningitis?
Which drugs to NSAIDs decrease the effectivness of?
- can lead to hyperkalemia
PUD with SSRI and NSAIDs?
SSRI may lead to depletion of serotonin in platelets, which is thought to play an important role in hemostasis
Which drugs increase PUD bleeding with NSAIDs
DONT DO IT
Aspirin and Nonacetylated Salicylates
Acetyl salicylic acid
Magnesium & choline salicylate ( Trilisate)
Magnesium salicylate ( Doan’s Pills)
Choline salicylate (Arthropan)
ASA dosage for mild pain
ASA dose for arthritis
ASA dosage for antiplatelet effect, angina, MI, CABG
How much blood loss in lost every day if ASA routinely used?
teaspoon in stool
Hyperpnea with ASA
high respiratory rate -> resp. aslk
antidote: stomach irrigation, IV fluids, sodium bicarb
less effective than ASA
dont use for antiplatelet effect
COX 2 selective NSAIDS
COX 2 selectives
-the idea there would be more anti-inflammatory effect and less effect on stomach
-more CVS events (MI, stroke). This is because they inhibit COX-2 mediated prostacyclin synthesis in vascular endothelium
not protective of kidney blood flow but seem to cause fewer GI problems & less bleeding
What theraputic effect do COX 2s have?
-Sulfa: can get a rash if allergic to sulfa
-Long-term use of celecoxib may cause an increased risk of serious adverse cardiovascular thrombotic events, MI, and stroke, which can be fatal.
3 main Nonselective NSAIDs and their dosages
-Diclofenac (Voltaren)- 50 mg and 75 mg twice a day
-Ibuprofen (Motrin, Advil) 800 3 day
-Naproxen (Naprosyn, Aleve) 550 twice a day
IM NSAID is called...
-IM loading dose, then oral max 40 mg/day
-use 5 days or less
-dont use for inflamation
3 NSAIDs with long 1/2 life -- ONCE DAILY DOSING
not effective for gout
how long do you give an NSAID before you switch?
cases where you should avoid using NSAIDs
have CHF, renal failure, active peptic ulcer disease, uncontrolled HTN
Is it okay to combine 2 NSAIDs?
NSAID in pts with hx of high BP
check BP before starting and every two weeks
if high stop or give more HTN meds
What do you use if PUD and over 70?
Celebrex w/ PPI, and Misoprostol
-oral or rectal
-onset in 30-60 min
less than 3 grams/day
metabolized by liver and is toxic
What are the theraputic properties of APA?
-analgesic and antipyretic
NOT ANTI INFLAMTORy
Adverse effects of APAP
dizziness, excitment, disorientation
APAP antidote is...
can you add APAP to NSAIDs?
Neuropathic Pain Relievers
amitryptyline- migraine and diabetic neuropathy
Two topical Pain Relievers
- Methyl slicylate (wintergreen oil)
lidocaine/Prilocaine EMLA cream
release substance P, continuously stimulates nerve (hurts at first), continuous nervestimulation deplets substance P, works best for neuropathic pain
you can cut it